Contraindications, precautions and answers to some frequently asked questions about influenza vaccination
Who should not receive the vaccine?
Influenza vaccination is contraindicated for individuals who have had documented anaphylaxis to any ingredient in the vaccine except egg,1 or a previous dose of inactivated influenza vaccine. These individuals should not receive the vaccine.
Spacing of the mRNA-CV (COMIRNATY™/Pfizer-BioNTech COVID-19) vaccination and other vaccines2
UPDATED 15 March 2021: In view of the absence of data on concomitant delivery, and to minimise confusion with any associated reactions, a gap of two weeks is generally recommended between giving mRNA-CV after any other vaccine. However, based on first principles of how these vaccines work, adverse impacts on immunogenicity or safety are unlikely with a shorter gap, so if it is clinically important to deliver in a shorter time, do not delay.
- If it is not practicable to keep a two-week gap between vaccines, then do not delay.
- If a live vaccine has been administered, wait four weeks before giving a COVID-19 vaccine but if not practicable, then do not delay.
- If a COVID-19 vaccine is administered first, then maintain a two-week gap before any other vaccines.
Note: the second mRNA-CV dose is given at least 21 days after the first dose.
Immune checkpoint inhibitors and vaccination
UPDATED 16 March 2021: A person who is currently receiving any of the immune checkpoint inhibitor treatments, atezolizumab (TECENTRIQ®), ipilimumab (YERVOY®), nivolumab (OPDIVO®) and pembrolizumab (KEYTRUDA®), or who has received any of these in the previous six months can receive any non-live vaccine, e.g., influenza or COVID-19, without consulting their specialist prior to vaccination. The administration of live vaccines (MMR, VV, HZV) is contraindicated.
Anticoagulant medication and vaccination
Influenza vaccines can be administered to people on anticoagulants, including aspirin, dabigatran (PRADAXA®), enexoparin (CLEXANE®), heparin, rivaroxaban (XARELTO®), ticagrelor (BRILINTA™) and warfarin.3 After vaccination, apply firm pressure over the injection site without rubbing for 10 minutes to reduce the risk of bruising.
Please refer to the Medsafe website medsafe.govt.nz for the PRADAXA, CLEXANE, XARELTO and BRILINTA data sheets.
Egg allergy or anaphylaxis
FLUAD QUAD, AFLURIA QUAD, INFLUVAC TETRA or AFLURIA QUAD JUNIOR can be safely administered to people with a history of egg allergy or egg anaphylaxis at general practices, pharmacies or at the workplace, although the data sheet advises caution in people who have a history of egg anaphylaxis. Studies have shown that influenza vaccines containing one microgram or less of ovalbumin do not trigger anaphylaxis in sensitive individuals.
Sulfonamide (sulfer) allergy or anaphylaxis
Sulfonamide (sulfur) antibiotics, such as cotrimoxazole, sulfasalazine, and sulfite preservatives used in food, are different to medicines containing the words sulfate or sulphate, e.g. neomycin sulphate.
- FLUAD QUAD vaccines contain traces of kanamycin and neomycin.
- INFLUVAC TETRA vaccines contain traces of gentamicin.
- AFLURIA QUAD and AFLURIA QUAD JUNIOR vaccines contain traces of neomycin and polymixin B due to their use during production.
The vaccines should be used with caution in people with known anaphylaxis to these respective antibiotics.
Seafood, shellfish or other food allergy or anaphylaxis
- People with a seafood or shellfish allergy or anaphylaxis can receive influenza vaccine, including FLUAD QUAD that contains the MF-59 adjuvant derived from shark liver.
- A person with confirmed allergy or anaphylaxis to chicken meat or chicken protein should discuss whether to receive an influenza vaccine with their immunologist. In making the decision with the person, the immunologist will balance the potential for residual chicken protein and the person's individual sensitivity with the risks of influenza and potential benefits of influenza vaccination.
- Allergy or anaphylaxis to other foods are not a contraindication for influenza vaccination.
FLUAD QUAD, AFLURIA QUAD and AFLURIA QUAD JUNIOR syringes do not have any components made using natural rubber latex.
INFLUVAC TETRA syringes do not contain any latex components. However, the manufacturer (Mylan) is unable to confirm that the product did not come in contact with any latex materials during the manufacturing and packaging process.
If no latex-free influenza vaccine is available, please call 0800 IMMUNE (0800 466 863) before vaccinating a person who is highly sensitive to latex with a history of severe hypersensitivity response.
Could influenza vaccination increase the risk of infection with coronaviruses or make COVID-19 disease worse?
No. Influenza vaccination does not increase the risk of being infected with the SARS-CoV-2 (COVID-19) virus or any other respiratory virus.
- Australasian Society of Clinical Immunology and Allergy. Vaccination of the egg-allergic individual [Internet]. Sydney: Australasian Society of Clinical Immunology and Allergy; 2017 [Available from: https://www.allergy.org.au/images/stories/pospapers/ASCIA_Guidelines_vaccination_egg_allergic_individual_2017.pdf
- Ministry of Health. Immunisation handbook 2020 [Internet]. Wellington: Ministry of Health; 2020 [updated 2021 March 15; cited 2021 March 17]. Available from: https://www.health.govt.nz/system/files/documents/publications/immunisation-handbook-2020-sep20-v7.pdf
- Kuo AM, Brown JN, Clinard V. Effect of influenza vaccination on international normalized ratio during chronic warfarin therapy. J Clin Pharm Ther. 2012;37(5):505-9.